Provider Demographics
NPI:1033649272
Name:IBARRA, BIANCA TARA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:TARA
Last Name:IBARRA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 E SIERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1221
Mailing Address - Country:US
Mailing Address - Phone:480-406-2979
Mailing Address - Fax:
Practice Address - Street 1:10439 S 51ST ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5222
Practice Address - Country:US
Practice Address - Phone:480-635-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health